Bill C-7 (Historical)

An Act to amend the Criminal Code (medical assistance in dying)

This enactment amends the Criminal Code to, among other things,
(a) repeal the provision that requires a person’s natural death be reasonably foreseeable in order for them to be eligible for medical assistance in dying;
(b) specify that persons whose sole underlying medical condition is a mental illness are not eligible for medical assistance in dying;
(c) create two sets of safeguards that must be respected before medical assistance in dying may be provided to a person, the application of which depends on whether the person’s natural death is reasonably foreseeable;
(d) permit medical assistance in dying to be provided to a person who has been found eligible to receive it, whose natural death is reasonably foreseeable and who has lost the capacity to consent before medical assistance in dying is provided, on the basis of a prior agreement they entered into with the medical practitioner or nurse practitioner; and
(e) permit medical assistance in dying to be provided to a person who has lost the capacity to consent to it as a result of the self-administration of a substance that was provided to them under the provisions governing medical assistance in dying in order to cause their own death.

Government Business No. 34—Proceedings on Bill C-62

[Pat Kelly, Conservative, Calgary Rocky Ridge, AB]

Madam Speaker, it is possible that my colleague misunderstood me. What I said in my speech was that I voted for Bill C-14 because it was a reasonable response to what had to be addressed, which was the Carter decision. The reasonable foreseeability of death was a problem clause, and I thought so at the time. I thought it was awkward and perhaps not the best way to put it, so it was not a shock to me that it ended up being challenged on that basis. I think my colleague may have been overestimating my enthusiasm for Bill C-14, but I did support it, because something had to be done.

However, this reckless expansion that came after the Senate amendments to Bill C-7 goes way beyond this. No court was calling upon Parliament or forcing Parliament to expand the eligibility of MAID to those whose sole underlying health condition is mental illness.

[Pat Kelly, Conservative, Calgary Rocky Ridge, AB]

Madam Speaker, it is quite difficult to follow the incredible words we just heard from the member for Cariboo—Prince George. Nevertheless, I am going to give it a try.

I am here tonight of course to speak to Bill C-62 and the self-inflicted debacle that has been unfolding in Parliament since it passed its radical expansion of legal medical assistance in dying to include persons for whom the sole underlying health condition is mental illness.

I will remind members of the House and my constituents that I supported and still support the principles of the 2016 bill, which was a necessary response to a 2015 Supreme Court ruling that struck down the blanket prohibition against MAID. That bill was not perfect, but it was a reasonable response to the Supreme Court's decision and was certainly better than the free-for-all on MAID that would have surely followed had there been no law.

It is my view that people who are suffering intolerably from a terminal disease without any hope of recovery or any prospect for improvement and are spiralling into a certain death as a result of illness or disease ought to be able to seek medical assistance in dying as long as they are not coerced, have received an option of proper palliative care, are not proactively offered MAID as an alternative to treatment, and most importantly, as long as the patient is a mentally competent adult.

Part of the criteria laid out in the original 2016 law was the reasonable foreseeability of death of the applicant. This clause was a problem from the start. It was challenged in court and struck down by the Quebec Superior Court. The Truchon case presented the Liberals with a decision point. The decisions the government has made since then have all been wrong.

The first thing the Liberals could have done, but did not, was defend their own existing law and appeal the Truchon decision to the Supreme Court. If they believed that their 2016 law was charter compliant, like they claimed it was during the debate in 2016, they should have stepped up and defended it. Not doing so was their first mistake.

The second mistake was that the then minister of justice was so eager to expand the law, they used the Truchon case as an opportunity to open up and expand access to medical assistance in dying and tabled Bill C-7 in the fall of 2020. That was their second mistake.

As I said before, I support MAID for competent adults who are grievously and irremediably ill and suffering cruelly from intolerable pain and anguish in the late stages of a terminal illness. I have consistently said there are important conditions for my support for legal access to MAID: the availability of quality palliative care as an option; the existence of robust safeguards for the vulnerable, especially minors, the disabled and the mentally ill; conscience protection for practitioners who oppose MAID; and any expansion of the availability of eligibility for MAID be well thought out, carefully considered and not rushed.

For these reasons, I voted to send Bill C-7 to committee, but voted against it at third reading because it failed on at least two, maybe three of my four conditions for support. I concluded that access to palliative care is not adequate in Canada. I have also become alarmed by the cracks in what should be the protections for vulnerable Canadians, as we have experienced in my own family. It was my view, even before the Senate amendment, that Bill C-7 was flawed and unworthy of support.

Then the House made a terrible decision when it passed the amendment that came back from the Senate. It was rightly opposed by all of my Conservative colleagues, who knew then that medical professionals cannot, with the certainty required for what is literally a life-and-death decision, determine irremediability of a patient in a case of mental illness. Conservatives opposed it, but it was passed nevertheless, and this expansion, which was not necessary to conform to any court decision, was to come into effect last year. The government had to introduce emergency legislation this time last year to give the medical system more time for this extraordinary change. That was the next mistake it made.

The Liberals could have used that opportunity to deal with this once and for all and simply strike this portion of what was then Bill C-7. However, they did not do it and here we are, another year later, and this country is no more ready for this expansion than it was this time last year. Here we are again in an eleventh-hour panic to kick this further down the road until after the next election; the next mistake.

Now, the Liberals could have tabled a bill that would have removed this from the bill that passed in 2021, but they have chosen not to and so said that the next government will have to deal this. However, the good news is that a Conservative government, which will surely be formed after the next election, will not recklessly expand the application of MAID to include vulnerable Canadians whose sole underlying health condition is a mental illness.

MAID is for people who cannot get better. It is for people who have no reason to hope that they can get better because they are in an irreversible, terminal state. It is for people capable of making a rational decision and not as a means of potentially fulfilling suicidal ideation.

The impossibility of creating a regime that could determine appropriate MAID for mentally ill but otherwise healthy people who are not in the final stages of a terminal illness seemed intuitive to me, but, of course, I am not a medical professional. However, I can also point to the clear message that was sent from the joint committee that studied this. Its recommendation to Parliament was very simple: Do not do it. It was the shortest list of recommendations I have ever read in a parliamentary report. It just said: Do not do it. That was the recommendation based on months and months of testimony from experts.

My recommendation to this government is to listen to the committee and strike it from the bill that passed. This time last year, the Liberals could have done that, but they kicked it ahead until this year, and nothing has changed. We find ourselves here where a full 80% of members of the Ontario Psychiatric Association do not believe that Canada can safely implement MAID for mental illness. Here we are just pushing this back a couple of years.

I want to share with the House the words of one of my constituents who met with me in November. She said in a letter to me, which I got before I met her, that, “Twenty-three years ago, age nineteen...I made the desperate decision to try and escape what appeared to me to be a dark world.... While taking a course in Pharmacology, I calculated the quantity of poison needed to arrest the heart of an adult male, multiplied it by three, and chose to ingest it.... I felt compassion for the suffering of others and the weight of constant, terrible news...though I formerly had the capacity to deal with this, the ingestion of a single pill coerced upon me by a well-intending physician inadvertently plummeted my thoughts into despair.”

What she told me later was that the side effect of the medication that she had been prescribed caused her to immediately become suicidal, and her survival was described as miraculous by the professionals who attended her.

She is now a wife and a mother and lives a productive, meaningful life. She is convinced that had MAID been available to her earlier in her life, she would have sought it and potentially have been granted it. She told me that the sufferings earlier in her life may well have been thought to be irremediable and thus would have made her eligible.

So, this government has failed to defend its original law. It failed to focus the new law on the narrow constraints of the Truchon decision. It used the Truchon decision in Quebec as an excuse for a reckless expansion of MAID. When it was obvious that it made a mistake, its members dithered instead of acting decisively and they are dithering now by pushing this two more years down the road. That is not leadership. This is just bizarre enthusiasm for the most radical expansion of MAID possible, which has now run amok.

So, I do support swift passage of the bill. Given the extensive debate that has already taken place, I was prepared to let it pass unanimously, but here we are. I had an opportunity to get some of my thoughts on the record, and I am happy to take questions.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Mr. Speaker, it seems to me that we have gotten ourselves into trouble with the use of arbitrary timelines. The Senate amendment to Bill C-7 kicked the can down the road two years. Last year's Bill C-39 added a year, and now Bill C-62 would add three years.

I just want the member to put that into the context of the fact that the health ministers of seven out of 10 provinces and all three territories have asked for an indefinite pause. The special joint committee, likewise, was very careful not to put a timeline in its recommendation for a pause.

How does the member reconcile this three-year pause with the fact that those institutions, those provincial governments, would rather put more of a qualitative benchmark than a timeline on it?

[Andréanne Larouche, Bloc, Shefford, QC]

Mr. Speaker, the member for Salaberry—Suroît is a tough act to follow. This is not easy, because we all have someone in mind when we talk about this. We have all lost loved ones over the past few months and years. We all have gone through different experiences. Some people request medical assistance in dying, others do not, but one thing is certain: this is a very sensitive topic. It is with great humility and sensitivity that I rise today to speak to Bill C-62, an act to amend An Act to amend the Criminal Code (medical assistance in dying), no. 2, something we have been talking about for a long time.

We must act by considering the fact that, currently, the Government of Quebec's Bill 11 does not include non-neurocognitive mental disorders as being eligible for medical assistance in dying and that Quebec wants to fill the administrative void surrounding the federal government's position on the subject of mental disorders relative to neurocognitive disorders. Therefore, I am not here to repeat my whip's testimony. I am here to provide some background and talk about Quebec's specificities. I will close by going into more detail about the Bloc's position.

First, in 2014, Quebec passed the Act Respecting End-of-Life care after five years of consultations and of working together across party lines. I want to emphasize that the work was non-partisan. In 2015, the Supreme Court ruling in Carter indicated that some provisions of the Criminal Code that prohibited medical assistance in dying contravened the Canadian Charter of Rights and Freedoms. In 2016, the Liberal government passed Bill C-14, in response to Carter. In 2019, the Quebec Superior Court ruled in favour of Nicole Gladu and Jean Truchon, who claimed that excluding people whose death was not reasonably foreseeable from eligibility for medical assistance in dying was discriminatory. As a result, the court ordered that federal and provincial laws be amended before December 18, 2020.

In 2021, after a pandemic-related delay, Parliament passed Bill C‑7, which created two pathways to medical assistance in dying: One for those whose death is reasonably foreseeable and one for those whose death is not reasonably foreseeable. Quebec simply chose to drop the end-of-life criterion. Bill C‑7 required that an expert panel be created to review MAID and mental illness. The Expert Panel on MAID and Mental Illness was formed in August 2021 and produced a final report containing 19 recommendations. Recognizing that the legislation was flawed and that issues related to medical assistance in dying remained unresolved, Bill C-7 created the Special Joint Committee on Medical Assistance in Dying, composed of members of the Senate and members of the House of Commons, which had a five-part mandate.

The joint committee tabled an interim report on June 22, 2022. There was not much time between the tabling of the joint committee's report, which was initially expected in 2022, and the March 17, 2023, deadline for excluding people from MAID for mental illness, so members postponed eligibility for one year to allow the committee to finish its work. The goal was to give the professions involved more time to develop standards of practice. At last, in February 2024, the joint committee produced its final report. The report contains only one recommendation. Bill C‑62 implements the report's recommendation by postponing eligibility for MAID MD-SUMC, for mental disorders, for three years and by forcing the creation of a joint committee one year before the report.

Sections 241.1 to 241.4 of the Criminal Code govern medical assistance in dying in Canada. What is more, under the law, the government is required to oversee the use of medical assistance in dying via the Regulations for the Monitoring of Medical Assistance in Dying. I am providing all of this background to illustrate that the government could have and should have taken action a long time ago.

Second, in Quebec, medical assistance in dying is governed by the Act Respecting End-of-Life Care. The activities surrounding medical assistance in dying are supervised by the select committee on end-of-life care. In June 2023, the National Assembly of Quebec passed Bill 11 to expand access to medical assistance in dying in Quebec and harmonize Quebec's legislation with the Criminal Code. There are some notable changes to Quebec's legislation. Minister Sonia Bélanger and her colleagues Roberge and Jolin‑Barette held a press conference on February 7 calling on the government to include a provision in the Criminal Code that would allow Quebec to move forward with advance requests, because, even though Quebec's legislation allows it, the Criminal Code does not.

Although doctors who choose to go ahead with advance requests are unlikely to be prosecuted by Quebec's attorney general, the risk of a civil lawsuit is still there, and that will make many doctors think twice about granting advance requests. Quebec's National Assembly has passed a unanimous motion demanding that the federal government legislate on the issue.

Third, the Bloc Québécois will vote for the bill on the condition that the postponement is for one year, not three. The Bloc Québécois believes that eligibility for people suffering from mental disorders must be postponed so that Quebec, the provinces and professional bodies can create a framework for their MAID practices. However, it should not be postponed indefinitely. The Bloc Québécois believes that postponing eligibility by three years will prolong the suffering of individuals who could be eligible for MAID and is contrary to their rights as guaranteed by the charters. The Bloc Québécois wishes to point out that the report of the Expert Panel on MAID and Mental Illness, as well as the Collège des médecins du Québec, emphasized that the safeguards—namely irremediability, severe physical or mental suffering, and free and informed consent—currently provided for in the Criminal Code are sufficient to allow access to MAID where mental disorder is the only underlying condition.

In our supplementary opinion attached to the report of the Special Joint Committee on Medical Assistance in Dying, the Bloc Québécois points out that, even though preparations on the ground for medical assistance in dying when a mental disorder is the sole underlying medical condition are not yet complete across Canada, this does not change the fact that several professional associations, including the Collège des médecins du Québec and the Association des médecins psychiatres du Québec, would still like it to be made available in the future.

The Bloc Québécois also acknowledges the requests made by several provinces to postpone eligibility. It should be noted that many countries have adopted policies on medical assistance in dying specifically for mental disorders.

The Bloc Québécois deplores the government's failure to be proactive and the Conservatives' obstruction on the issue of medical assistance in dying when a mental disorder is the sole underlying medical condition and on the issue of advance requests. We fear for the patients who will have to turn to the courts to assert their rights while also bearing the burden of their illness.

Finally, the Bloc Québécois condemns the fact that this bill does not distinguish between mental disorders and neurodegenerative diseases, such as Alzheimer's and Parkinson's. Quebec's law makes that distinction. It would allow people suffering from the latter category to access medical assistance in dying, as advocated by the Quebec government. In the Bloc's opinion, the social consensus on these illnesses is stronger, and it would have liked to see the Criminal Code brought into line with Quebec's end-of-life care law by allowing advance requests.

In his supplementary opinion on MAID, the member for Montcalm, whom I would like to congratulate for all his work on this issue, went into great detail on the reasons that justify MAID when a mental disorder is the sole underlying condition. The position of the Collège des médecins du Québec perfectly sums up the importance of allowing advance requests for medical assistance in dying, as well as medical assistance in dying when a mental disorder is the sole underlying condition. While admitting it needs more time to ensure its members are ready, the Collège des médecins du Québec has established five guidelines for assessing eligibility for medical assistance in dying.

In conclusion, the Bloc Québécois has a humanist view of medical assistance in dying that is grounded in philosophical principles and ethical arguments that reflect the evolution of Quebec society. Medical assistance in dying recognizes the right of individuals to choose for themselves, to determine the conditions for a healthy and dignified life. Medical advances allow us to sustain life, but that does not preclude the need and right of the individual to define what is an acceptable life. Section 1 of the Quebec Charter of Human Rights and Freedoms states that every human being has a “right to life, and to personal security, inviolability and freedom”.

Quebec society believes that the right to life includes the right to die. In that context, we need to see medical assistance in dying as a right that gives the individual the option of avoiding terminal suffering and medical paternalism in order to maintain their dignity. By allowing medical assistance in dying, we allow people to choose how, when and where they want to pass away.

Medical assistance in dying only makes sense if the person's free and informed consent is respected. The word “free” means voluntary and without constraint, and the word “informed” means with all the information needed to make such a decision. Meeting this condition is necessary for accessing medical assistance in dying.

The principles we stand for concerning medical assistance in dying are equally valid in cases of mental illness. Let us not forget that the possibility of access to MAID does not mean automatic eligibility. However, when the Quebec select committee was doing its work, it made a distinction between mental disorders and neurodegenerative diseases. The commission concluded that although there was no consensus on mental disorders, there was a consensus on neurodegenerative diseases. With that in mind, the Quebec government opened the door to advance requests. Advance requests allow an individual to determine the conditions under which MAID should be administered when they have lost the capacity to consent because of their illness.

In its second report, the Special Joint Committee on Medical Assistance in Dying expressed its support for advance requests. All parties, except the Conservatives, who are against any form of medical assistance in dying, voted in favour of the recommendations.

As a final point, the federal government therefore has no reason to drag its feet or to deny Quebec's request.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Mr. Speaker, on the situation we find ourselves in this week, and last year with Bill C-39, we can draw a direct line back to the Senate amendment that was placed on Bill C-7. The government did a complete 180. It came out with a charter statement explaining why it was excluding mental disorders, and it then went and accepted the Senate amendment.

Bill C-39 last year had to punt the ball down the road by a year. Now we have Bill C-62 trying to do that by another three years. It feels like everything we have been doing has been trying to play catch-up to that change in the law. The law was changed before we had done the work.

Does my hon. colleague regret voting for that Senate amendment, given all he knows now and all of the catch-up we have been trying to do on this very important and sensitive issue?

[Yasir Naqvi, Liberal, Parliamentary Secretary to the Minister of Health]

Mr. Speaker, I appreciate being recognized to speak to a very sensitive and emotional issue.

Today, I am pleased to be speaking to Bill C-62. This bill proposes extending the temporary exclusion from MAID for people whose sole underlying medical condition is mental illness.

We are proposing that the exclusion be extended by three years. To understand why an extension of this exclusion is so important right now, we need to look at how we got to this point in the legislative process.

As members know, former Bill C-7 was enacted in response to the Quebec Superior Court Truchon ruling. The ruling found that the original MAID legislation, which required a person's natural death to be reasonably foreseeable, contravened the Charter of Rights and Freedoms.

The former Bill C-7 received royal assent and became law on March 17, 2021. This law included a temporary two-year exclusion of eligibility for individuals suffering solely from mental illness, which meant that such persons would become eligible to receive MAID starting March 17, 2023, if they met all other eligibility criteria. The intent of this two-year delay was to allow an expert panel to undertake an independent review and to provide recommendations respecting any protocols, guidance and safeguards that should apply to requests for MAID by persons with a mental illness.

I will be sharing my time with the member for Richmond Hill.

On May 13, 2022, the “Final Report of the Expert Panel on MAiD and Mental Illness” was tabled in Parliament and released publicly. The expert panel noted that MAID clinicians are already assessing very complex cases and concluded that certain assessment challenges, such as determining incurability or assessing decision-making capacity, are not unique to MAID requests from persons with a mental disorder, nor are they applicable to every requester who has a mental disorder. The expert panel also concluded that the existing MAID eligibility criteria and safeguards in the legislation provide an adequate structure for MAID where a mental disorder is the sole underlying medical condition, as long as they are interpreted and applied appropriately.

The expert panel's recommendations provide guidance to support complex MAID assessments. In its final report, the expert panel made 19 recommendations, laying out a broad set of principles that could structure the practice of MAID not only for persons with a mental disorder but also for those with other conditions where concerns may arise related to incurability, irreversibility, decision-making capacity, suicidality and/or the impact of structural vulnerability, regardless of the person's diagnosis.

The government supports the insights and general advice emerging from the panel's work. Let me take a few minutes to highlight some of the key achievements.

The expert panel report recommended the development of national practice standards on MAID for mental disorders and other complex cases. Practice standards help regulatory bodies evaluate the appropriateness of the clinical decisions of health professionals who assess and provide MAID. They also provide clarity to MAID clinicians regarding their professional obligations. In March 2023, a model practice standard for MAID was released along with a companion document of advice to the profession, which provides a series of questions and answers that elaborate upon specific clinical questions raised by the model standard.

That is not all we have done to help prepare a safe approach to providing medical assistance in dying across Canada.

We are providing $4.9 million to the Canadian Association of MAiD Assessors and Providers to develop and deliver an accredited, Canadian-made curriculum to support practitioners. This consists of seven training modules that address various topics related to the assessment and provision of MAID, including guidance in how to assess capacity and vulnerability, how to navigate more complex cases and how to assess MAID requests with mental illness as the sole underlying condition. The MAID curriculum was launched in August 2023. Over 1,100 clinicians have registered for it.

From when MAID legislation was enacted in 2016 to the end of 2022, over 44,000 Canadians received MAID. The vast majority of these individuals were at the end of their life. In fact, numbers from 2022 show that 96.5% of individuals accessing MAID were terminally ill, and two-thirds had a cancer diagnosis. Many more requested MAID but were ruled ineligible based on the strict eligibility criteria and safeguards, withdrew their requests or died before receiving MAID. This is not unexpected.

The government recognizes that public reporting is critical to ensuring transparency and public trust in the legislation. Both the original MAID legislation of 2016 and the amended law passed in 2021 set out obligations for the collection of data and public reporting on important aspects of MAID. As of January 1, 2023, we have expanded our collection of information on MAID.

I would like to take this opportunity to highlight the achievements of the provinces and territories, as well as key partners in the system, such as health care professionals, who are working to safely implement MAID within their health care systems.

We have come a long way, but we have heard clearly that there is more work to be done. More preparations are required within the provincial and territorial health care systems to support the wraparound activities that may be necessary for the management and assessment of MAID requests where mental illness is the driver.

We also know that some Canadians and members of the medical community are concerned about expanding eligibility for MAID to people suffering solely from mental disorders.

We will continue the work with the provinces, territories and key health system partners to support the safe implementation and delivery of Canada's framework for MAID, while protecting those who may be vulnerable. The expert panel also recommended consultations with first nations, Inuit and Métis people. We recognize the importance of meaningful engagement and ongoing dialogue with indigenous peoples to support the culturally safe implementation of MAID.

Working in partnership with indigenous communities, we have developed an extensive plan for indigenous engagement. Our approach involves both indigenous-led community engagement and federally supported activities, such as an online tool, which has already been launched, and knowledge-exchange round tables, which will be taking place this February to April. We are working closely with indigenous partners to design a process with them at their pace.

I recognize that there is a lot of hard work being done in order to show that MAID is accessible to people who need it, with appropriate safeguards in place. However, we need to make sure that we do not rush into that decision. This is why it is really important that we extend the application of this particular bill, as it relates to people with mental disorders, by at least three years; as a result, all provinces and territories can have the appropriate training and assessment tools ready.

A year ago, we extended the exclusion period for one year, until this March. As we approach that date, we have heard unanimously from all provinces and territories that their health care systems are at various stages of readiness, and there is more to be done.

The decisions we are making about MAID are not easy to make, nor should they be.

These are life-and-death decisions and we must get this right.

In Bill C‑62, the government has put forward a three-year extension of the exclusion from eligibility for MAID for people suffering solely from mental illness.

I urge all members of this House to support Bill C-62.

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Mr. Speaker, I agree with many points my hon. colleague made in her speech. It is why I voted against the Senate amendment to Bill C-7 in the previous Parliament. It is why I voted for the member for Abbotsford's bill, Bill C-314. It is why I agree with the recommendation that came out of the special joint committee.

There is more than enough blame to be assigned to the Liberals, but we are dealing with a March 17 deadline. This is a time the House collectively has to stand up and get this bill through because we also have the Senate to deal with.

Why, with that context upon us right now, did the Conservatives vote the way they did this morning when it is imperative that this bill get passed before March 17?

We do not yet know what is actually going to happen in the Senate. We can only really say for certain what is going to happen in the House, but this is a critically important bill to pass before March 17.

Proceedings on Bill C-62

[Branden Leslie, Conservative, Portage—Lisgar, MB]

Madam Speaker, before I give my speech on this very important topic, I would like to quickly comment on the horrific incident we faced in southern Manitoba over the weekend with the tragic loss of life of two young women and three children. As a father, it is tough to fathom the loss of a child and the impacts it would have on that family's loved ones and friends. It would impact everyone in their lives and, frankly, the broader community.

My heart goes out to those of Carman and the surrounding area, and to the friends, families and loved ones of the victims of this horrific incident. It is devastating news for a small community like that, where folks know their neighbours and look out for each other, so I pray for strength during a very dark and incredibly difficult time for our community.

To the issue at hand, we are more than a month away from the Liberal government implementing medical assistance in dying for those who suffer from a mental illness. I believe this is heartless, reckless and immoral. Every Canadian has worth, and I, for one, will never give up on those who need help.

Never have I seen a government mismanage an issue as critical as this, and while it may be unpleasant for my Liberal colleagues to hear, I believe they must be held to account. Due to the incredibly serious nature of this issue, there is a lot to be answered for. How could the Prime Minister let this happen and let it get to this point? How could the government be so irresponsible and negligent?

From day one, our Conservative team in Parliament has been sounding the alarm bell, but we were ignored, and we now find ourselves in an emergency. I believe it is ludicrous that it took the outcry of countless medical professionals to get the Liberals to reverse course on this matter. Witness after witness testified to the Special Joint Committee on Medical Assistance in Dying about the dangers of pressing ahead with this plan.

Why did the Prime Minister accept the last-minute amendments put forward by the Senate that dramatically changed the legislative framework for MAID? There was no parliamentary study. There was no consultation with experts or affected groups and no evidence that MAID for mental illness could be implemented safely and appropriately. When the Liberals' original bill, Bill C-7, was put before MPs, at no time did it contain any language about creating a pathway for MAID for those with mental illnesses. In fact, it explicitly ruled that out in its entirety.

The original proposed amendment to the Criminal Code specified that “persons whose sole underlying medical condition is a mental illness are not eligible for medical assistance in dying”. The then Minister of Justice said, “there is no consensus among experts on whether and how to proceed with MAID on the basis of mental illness alone.” The minister then did a 180° and became a proponent of this disastrous course. Due to his actions, and the Prime Minister's rubber-stamping of the those Senate amendments, we are where we are today.

This is now the second time the Liberals have had to delay the implementation of their reckless legislation. There will never be a consensus from mental health experts that the government should implement MAID for those who are suffering from a mental illness, and if the Liberals will not listen to me, I implore them to listen to their own expert panel on MAID and mental illness, when it said it is implausible to determine whether a mental disorder is incurable.

The panel's report said, “There is limited knowledge about the long-term prognosis for many conditions, and it is difficult, if not impossible, for clinicians to make accurate predictions about the future for an individual patient.” That was echoed by the heads of psychiatry departments of all 17 medical schools, who called on the Liberals to stop this plan from being implemented on March 17.

I completely agree with these experts, but not only should we pause this law from being implemented, we need to permanently end it once and for all. Let me be perfectly clear. Instead of delaying, the government needs to introduce a bill to ensure that it never happens.

When I ran to become a member of Parliament, this was a key plank of my platform. I pledged to do everything I could to stop the Liberals from ever implementing this dangerous idea, and the sad reality is that the Prime Minister—

[Elizabeth May, Green, Saanich—Gulf Islands, BC]

Madam Speaker, I appreciate the opportunity to speak to this. Having been in this place for all the debates we have had, I have been trying to figure out the best way to explain to Canadians, if there is an argument here, why it is not between Liberals and Conservatives, or between Greens and NDP and Conservatives and the Bloc. It has actually been, from the very beginning, a struggle for Parliament to actually deal with an issue we have been kicking down the road for too long.

I mentioned earlier in debate, as the member for Saanich—Gulf Islands, the quiet and extraordinary courage of a single woman, Sue Rodriguez, who took her irremediable medical condition of suffering all the way to the Supreme Court of Canada and was denied the opportunity for what is generally called death with dignity. She had the procedure illegally. Those who were with her at the time would have been subject to criminal penalty as well, including my friend Svend Robinson, who at the time was member of Parliament in a different party from a different place.

It was a very fraught time, and the issue of medical assistance in dying kept coming back to me from constituents who were heartbroken that their parents or loved ones had to go through suffering. Quite often people would say to me they would not let a family pet go through this kind of suffering so why do we allow our moms and our dads to go through this when there is no prospect they are going to recover.

This finally went back to the Supreme Court of Canada for a different decision that came out of the Carter case. The Carter case, back in 2015, said that refusing to allow someone the legal option to seek medical assistance from their doctor in a situation where their illness is terminal is really a violation of section 7 charter rights. I only mention this because that was also with a deadline. We have to take action on this; we cannot just leave the matter. The Supreme Court of Canada has said that this provision of the Criminal Code is actually a charter violation. That means one cannot let it just sit there anymore.

It would take too much time, and my colleagues will be relieved to know I will not go through this chapter and verse, but it is a tough, tough issue for parliamentarians. At the time, as we started debating the first iteration of allowing for death with dignity, in Bill C-14, our first Minister of Justice to deal with this was the very honourable Jody Wilson-Raybould. She had to struggle with this. Our Minister of Health at the time, also very honourable, Jane Philpott, was struggling with this.

It occurred to me as the debate went on that what we had in Canada on this issue was essentially a professional dispute. The lawyers in Canada wanted to make sure that the charter was respected. The doctors in Canada said they did not want to be asked to figure out what “irremediable” meant and were not exactly ready for that. Therefore, subsequent revisions kept happening because, after all, in our first attempt to get medical assistance in dying right, we did not allow for advance directives. Therefore, we had subsequent court cases where people who had terminal cancer could not access MAID because they decided they better ask for it now, which was maybe months before death would occur naturally and months before a doctor could say, “Okay, you're ready now. Nod.” One had to be able to physically sign; the day of, one had to confirm one's procedure.

Again, I better not go back through all of this, but essentially the professional views of doctors pleading with parliamentarians outweighed the lawyers dealing with parliamentarians to say that we were probably still going to have charter violations, but it is better that we listen to the doctors and that they are ready. All of this ended up taking us back to fixing medical assistance in dying again to try to make it more humane, to try to respond to the concerns of Canadians from coast to coast that they wanted to be able to access an advance directive in a situation that fit the MAID template. This brought us to Bill C-7.

To some of the comments that were made in this place earlier today, the government and Parliament were under a deadline that was court imposed, not politically imposed, to oblige ourselves, as parliamentarians, to meet what the Supreme Court of Canada said the charter required us to do. We had a very tight timeline, and then the Senate did something I do not think anyone in the House expected.

Again, we had a professional dispute going on here. Doctors were saying they were not ready to extend this to people whose sole irremediable condition is mental illness. Public health professionals in addiction and mental health were saying they were not ready. However, with strong pressure and strong professional advice from the psychiatric community, the Senate decided we should extend MAID to those with an underlying condition that is only, and I do not say “only” as if it is a marginal or trivial matter, a crushingly painful and life-ending threat from mental illness.

We are walking this fine line. The line is even finer when we start realizing who is more likely to not be able to access mental health supports; they are the marginalized and the poor. Who is more likely to not be able to imagine continuing on in life with a crushing mental illness? It is again the marginalized communities. The disability community spoke with a loud voice saying not to extend MAID as they were worried enough that it was a slippery slope when Bill C-14 first came in, and now Bill C-7.

Here we are again with a court-imposed deadline. Let us be clear to Canadians watching today. Certainly, the provinces and many doctors and mental health professionals have spoken with one voice. If we do not act quickly to pass this legislation and if the Senate does not act quickly to get it to royal assent come March 17, then as a matter of reality, we are up against March 17, and medical assistance in dying would become available to people where mental illness is the sole underlying condition.

Is it irremediable? We are told by the experts that no one really knows how to answer that question. Yes, some of the psychiatric community says the safeguards are there and if three psychiatrists say that it is irremediable, then that is enough. However, we are all asking where the mental health supports are, particularly for those who are marginalized. Where is the access?

This is one that particularly perturbs me. I have had many people come to me from a community that has experience with using psilocybin, conventionally known as magic mushrooms, as a way to alleviate a mental health condition, which might otherwise be irremediable, with remarkable results. We know that Health Canada is currently accelerating trials on psilocybin. It strikes me as beyond a catch-22 that the authorities would say to those people and to their doctors, who think psilocybin could help them, when the alternative is that they are more likely to commit suicide, or if we do not act by March 17, they will have access to legal medical assistance in dying, and it would be too dangerous to let them try psilocybin, but the alternative is death. It seems to me that any medical risks from psilocybin pale in comparison to the irreversible reality of death. How can we let this happen? We cannot.

I think we need to discuss another thing in this place, which is societal assistance in living. We know what medical assistance in dying looks like, but what does societal assistance in living look like? It means ending poverty and bringing in a guaranteed livable income for all. It means access to mental health services in this country. It means a compassionate and caring approach that says to every Canadian, whether in the disability community, the indigenous communities or the youth who are struggling with addictions, that we hear them and will not fail them. That means, no matter how members feel about it, we have to pass this legislation expeditiously.

[James Maloney, Liberal, Etobicoke—Lakeshore, ON]

Madam Speaker, I think it is my assistant calling me, telling me it is time to speak. She is very efficient.

As I was saying, the bill proposes to extend the temporary mental illness exclusion, so that the provision of medical assistance in dying, or MAID, on the basis of mental illness alone would remain prohibited until March 17, 2027. In my remarks today, I will be addressing some of the concerns that have been expressed about allowing MAID for mental illness and the importance of ensuring that our health care system is ready before legalizing this practice.

As members know, Bill C-7 temporarily excluded MAID for mental illness until March 2023. Parliament extended the exclusion for an additional year after organizations such as the Association of Chairs of Psychiatry in Canada and the Centre for Addiction and Mental Health expressed a need for additional time. The Special Joint Committee on Medical Assistance in Dying, or AMAD, also supported the extension.

At the outset of my remarks, I want to emphasize that the government recognizes that mental suffering may be as severe as physical suffering. We know that not all individuals with a mental illness lack decision-making capacity. The extension of the temporary exclusion of eligibility for MAID is not based on these stigmatizing stereotypes.

I also want to announce my profound sympathy for anyone in Canada who is intolerably suffering because of a health disorder. My thoughts are with them.

While the federal government believes that MAID eligibility should be expanded to those whose sole condition is a mental illness, this process cannot be rushed. Over the past year, important progress has been made to prepare for the expansion, but provinces and territories are at varying stages of readiness. The federal government has listened to its partners and introduced this bill as a direct response to their concerns.

A cautious, deliberate and rigorous framework is essential to ensure the safe provision of MAID where a mental illness grounds a request for MAID. Debate about the parameters of the MAID regime has been taking place since before the Supreme Court of Canada's 2015 decision in Carter, in which it held that the absolute prohibition on physician-assisted dying was unconstitutional. This is a sign of a healthy democracy.

Most recently, the Special Joint Committee on MAID witnessed the diversity of views and expertise first-hand. Some witnesses who testified, such as Dr. Trudo Lemmens, chair in health law and policy at the University of Toronto, expressed concerns about permitting MAID where the sole underlying condition is a mental illness. Others, including the members of the Canadian Association of MAID Assessors and Providers, thought the country was ready for the current March 17, 2024 deadline.

Still others supported expanding MAID for mental illness, or accepted that it would become legal but recommended a delay. This recommendation came from Dr. Jitender Sareen of the University of Manitoba on behalf of eight chairs of psychiatry departments in Canada. The chairs of psychiatry outlined several reasons, including concerns about a need for further safeguards and accepted definitions of irremediability in mental disorders, before moving forward.

I would like to acknowledge the important contributions that have been made on this topic. While not everyone agrees, it is clear that we all care deeply about the well-being of those seeking MAID and the protection of the vulnerable.

Let me now get into some of the specific concerns that have been raised. Members will recall that certain eligibility criteria need to be met to qualify for MAID. This includes having a grievous and irremediable medical condition, which requires that a person be in an advanced state of irreversible decline.

Some doctors, such as Dr. Sonu Gaind, chief of psychiatry at Sunnybrook Health Sciences Centre, have said it is impossible to predict which patients with a mental illness will get better; in other words, we cannot determine whether their illness is irremediable. However, other experts, including members of the expert panel on MAID and mental illness, suggest that the evolution of the illness and the response to past interventions can be used to assess irremediability, as is done with some physical conditions such as chronic pain.

Concerns have also been raised, by Dr. Sareen and others, that it is too difficult to distinguish between suicidality and a rational request for MAID when the request is based on a mental illness alone, because suicidality may be a symptom of the mental illness itself. Dr. Stefanie Green acknowledged that this can be complicated, but testified before the MAID committee that clinicians have a duty to assess every patient for suicidality. It is something that doctors do regularly in clinical practice. In addition, MAID assessments may involve suicide prevention efforts where warranted.

Another concern expressed by Dr. Tarek Rajji, the chair of the medical advisory committee at the Centre for Addiction and Mental Health, is that there was no consensus within the medical community about whether MAID should be available for persons whose sole underlying medical condition is a mental illness. However, others, including Dr. Green, note that the lack of consensus in the medical community is not unique to MAID.

A last concern that I want to address is that individuals are requesting MAID due to a structural and systemic vulnerability, such as lack of income and social supports. I want to be clear that the law requires that the suffering be due to illness, disease or disability, not poverty or unmet needs.

Our government is confident that the existing safeguards will ensure that only those who meet the eligibility criteria receive MAID. We are also determined to invest in social programs that can alleviate non-medical suffering and bolster social supports. Our MAID framework contains two sets of safeguards, one for requests where natural death is reasonably foreseeable and the other, more robust set for requests where natural death is not reasonably foreseeable.

The second set of safeguards would apply to cases where a mental illness is the basis of a MAID request. These include a requirement for a doctor or nurse practitioner with expertise in the condition to be involved in the assessment, a longer assessment period of 90 days, a requirement that the patient has been informed of the means available to relieve their suffering and has been offered consultations with relevant professionals, and a requirement that both assessors and patient agree that the patient has given serious consideration to the reasonable and available means of relieving their suffering.

In addition to these stringent safeguards, there is other guidance for doctors, nurse practitioners and regulators, including a model practice standard. Implementation of robust regulatory guidance and additional resources is ongoing, as is uptake of the nationally accredited bilingual MAID curriculum.

We are confident that, with more time, we can achieve readiness to ensure the safe provision of MAID in circumstances in which a mental illness grounds the request for MAID. We have made important strides, but work remains to be done to prepare health care systems and for more doctors and nurse practitioners to benefit from the available training and supports.

Our government thinks that three years is enough time to complete this work, so that our health care system is prepared when MAID for mental illness is permitted. In addition, we are proposing to add a requirement for a parliamentary review by a joint committee of both Houses of Parliament, to start within two years of this bill's receiving royal assent.

The committee will have six months to submit a report, including a statement of any recommended Criminal Code changes. This review will inform government action and ensure that they move forward only once the Canadian health care systems are ready.

With the March 17, 2024 deadline fast approaching, I urge everyone to work together to see that this bill is adopted before that date.

[Luc Thériault, Bloc, Montcalm, QC]

Mr. Speaker, my colleague participated in all three sessions on the issue. When Quebec tabled its report and when we voted on Bill C-7 in 2021, I was very reluctant to consider opening up MAID to mental disorders. However, I worked my way through the experts' report and I invite my colleague to read it again.

My colleague says there is nothing in the legislation. However, it does not have to be in the legislation. The regulations can set out the “how to”. Recommendations 10 and 16 are important safeguards.

Let us assume I am not questioning anything in my colleague's speech; the fact remains that, today, as I speak, there are people who are suffering irreversibly and intolerably.

What solution does my colleague have for those people?

[Francis Scarpaleggia, Liberal, Lac-Saint-Louis, QC]

Mr. Speaker, I joined the latest edition of the Special Joint Committee on Medical Assistance in Dying, which was mandated to deal specifically with the question of the health system's readiness for an extension of MAID to cases of severe mental illness, out of a sense of duty as this is a deeply serious matter for Canadian society, one on which I received correspondence from a great many concerned constituents.

At first, I humbly questioned my qualifications to sit on the committee. I am not a psychiatrist. I am not a medical doctor. I do not have expertise or experience in this area. However, in a democracy, not all is left to the experts. The people, through their elected representatives, set legal parameters in areas of public interest by way of legislation and regulations. In fact, that is what has been happening since 2016 on the issue of MAID.

That said, it is important to carefully listen to and consult the experts out of respect for the authority of knowledge and experience. This is the opposite, I might add, of the new populism.

I agree with the committee's recommendation that we should indefinitely postpone MAID where the sole underlying condition is mental illness, also known as MD-SUMC. The central issue in MD-SUMC is irremediability; that is the question of whether there is the possibility that a person with severe mental illness can be cured of their terrible suffering, a suffering not different from physical suffering.

Under the law, for a person to be deemed eligible for MAID, the illness must be irremediable; grievous and irremediable. The problem when we move from somatic, that is physical, illness to psychiatric illness is that irremediability becomes more difficult to establish. In the case of psychiatric illness, an accurate prognosis is infinitely more difficult to produce.

Because of the difficulty, in cases of mental illness, of offering a reasonably certain prognosis, the determination of irremediability will necessarily have to be based on a retrospective view; that is on an assessment of the extent of a patient's past treatments and whether the patient exhausted all treatment possibilities in a quest to be relieved of their suffering. The problem is that the MAID assessors will most likely not have been involved in past treatments, which makes it difficult to ascertain the quality of those treatments. When it comes to establishing irremediability in cases of mental illness, evidence has shown accuracy is poor. It is less than 50%, a coin toss.

To quote Dr. Sonu Gaind, one of the experts who appeared before the committee, “Worldwide evidence shows we cannot predict irremediability in cases of mental illness, meaning that the primary safeguard underpinning MAID is already being bypassed, with evidence showing such predictions are wrong over half the time.”

It should be pointed out that under our MAID law, clinical certainty about irremediability is not actually required. Here it is important to highlight the distinction between legal irremediability and irremediability in clinical medicine.

In the MAID law, “grievous and irremediable” has a different meaning than in medicine. It is defined as incurability, “be in an advanced state of irreversible decline” and “enduring...physical or psychological suffering” that is intolerable to the person and cannot be relieved “under conditions the person considers acceptable.”

In law, therefore, it is not necessary to establish irremediability with a degree of clinical certainty. Rather, both patient and assessor must come to the shared understanding based, among other things, on the assessor's analysis of the history of past treatments. There is an element of subjectivity on the part of both patient and assessor. Naturally, the assessor will bring their own philosophical biases, values and ethics to this subjective equation.

As Dr. Gaind suggested to committee members, “Try those mental gymnastics on your constituents. Convince them it was okay that their loved ones with mental illness got MAID, not because of a clinical assessment based in medicine or science, but because of the ethics of the particular assessor.”

An important issue in determining eligibility for MD-SUMC is being able to separate suicidal ideation from a considered request for MAID. It bears keeping in mind that suicide attempts are not always rash and impulsive, the product of a panicked state. This, in some ways, is a stereotype. Psychiatrists will say that some suicides are not frenetic but carefully planned in advance.

Dr. Tarek Rajji, chair of the medical advisory committee at the Centre for Addiction and Mental Health, told the committee, “There is no clear way to separate suicidal ideation or a suicide plan from requests for MAID.”

To again quote, Dr. Gaind:

We cannot distinguish suicidality caused by mental illness from motivations leading to psychiatric MAID requests, with overlapping characteristics suggesting there may be no distinction to make.

In the Netherlands, an assessment by an independent physician is required for MAID, and in the case of psychiatric suffering, a third assessment by an independent psychiatrist, preferably one with specific expertise regarding the patient's disorder.

The problem with Canada's law, as it stands, is that there is no requirement for one of the assessors of MAID eligibility to be a psychiatrist, yet psychiatric issues are exceedingly complex. Often a patient has more than one illness. It is said that 71% to 79% of psychiatric patients who died through MAID in the Netherlands had more than one psychiatric disorder.

We humans are not self-directed, rational atoms exercising unencumbered clear-eyed autonomy. We are not as free as we think. We are born into families and communities, and influenced by the opportunities they offer, and alternatively, by the constraints they impose on us.

I sometimes wonder if we are not in the process of turning personal autonomy into ideology. I say “wonder” because as a liberal, I have not been bestowed the gift of absolutism that has blessed ideologues.

Requests for MAID can be influenced by, even driven by, extraneous factors like poverty and isolation, that is by psychosocial factors. According to Dr. Gaind, “those with mental illness...have higher rates of psychosocial suffering.”

This all means that MAID assessors will be wrong over half the time when predicting irremediability, will wrongly believe they are filtering out suicidality and still, instead, provide death to marginalized suicidal Canadians who could have improved.

Archibald Kaiser, Professor at the Schulich School of Law and Department of Psychiatry, Faculty of Medicine at Dalhousie University added that “The Supreme Court concluded in 1991 that people with mental illness have historically been the subjects of abuse, neglect and discrimination.”

Dr. Gaind further underscored that “Suffering is cumulative, and life suffering unfortunately fuels much of the suffering of those with mental illness, even more so for marginalized populations.”

There is, in fact, the possibility that gender-based marginalization can influence requests for MD-SUMC. We know that in countries that allow MAID for severe mental illness, the ratio of women to men who seek MD-SUMC is two to one.

For their part, indigenous representatives have expressed serious reservations about expanding MAID to include mental illness. According to Professor Kaiser:

In February 2021...many distinguished indigenous signatories wrote to Parliament that the consultation ... has not been adequate and “has not taken into account the existing health disparities...we face compared to non-Indigenous people.” They said, “our population is vulnerable to discrimination and coercion...and should be protected against unsolicited counsel.”

We know there is systemic racism in the health care system. Ask the family of Joyce Echaquan. How would systemic racism influence the rate of acceptance of MAID requests of indigenous and other racialized peoples? That is a pertinent question.

As Dr. Lisa Richardson, Strategic Lead, Centre for Wise Practices in Indigenous Health, Women's College Hospital, told a Senate committee on February 3, 2021:

In an environment where both systemic and interpersonal racism exists, I don’t trust that Indigenous people will be safe. I don’t trust that anti-Indigenous prejudice and bias will not affect the decision making and counselling about MAID for Indigenous people, no matter how much education is given.

Indigenous communities, many of which have felt the scourge of high suicide rates, especially among youth, may have concerns about possible contagion effects of MD-SUMC on suicidality.

Then, there is the basic question of the ability of the health care system in Canada, already stretched to the limit, to handle an expansion of MAID.

According to Dr. Eleanor Gittens of the Canadian Psychological Association, as a country we have not yet established parity between available physical and mental care. To quote her, “Care and treatment of mental illness are not covered by medicare, nor is it readily accessible.”

We do not really know how many people would request MD-SUMC, and thus whether we have enough qualified assessors. By some estimates, we would have well over 2,000 patients a year getting MD-SUMC with countless more requesting eligibility assessments. I know there is dispute around that number.

Just because there is a published Health Canada standard for MD-SUMC and a training module does not mean the system is ready. A building built on a soft foundation is not ready for occupancy, no matter the level of completion of its structure. There are today no safeguards preventing poverty, housing insecurity, loneliness, etc., that is psychosocial factors, from significantly fuelling MAID requests of those suffering from mental illness.

I will quote Dr. Rajji: “The standards document itself, the one developed by the expert panel, states that these are not clinical guidelines, and this is what is missing to ensure quality.” According, again, to Dr. Gaind, “it is a legal fiction that determinations of the eligibility of MAID are based on objective clinical judgment. In fact, I regularly witness practitioners' values influencing the interpretation of the current MAID eligibility criteria and safeguards.”

As per an article in the review Impact Ethics, “The few jurisdictions allowing MAiD for [sole] mental illness have safeguards Canada lacks, notably (unlike Canada) requirement of due care and no reasonable alternative, or treatment futility, prior to MAiD eligibility.”

In Canada, a patient would be able to qualify for MD-SUMC even if they refuse treatment. Often a psychiatric patient will refuse additional treatment owing to treatment fatigue. While treatment fatigue has been studied in the context of HIV and type 1 diabetes, with the goal of developing strategies to help overcome it, treatment fatigue has not yet received attention in psychiatry. A better understanding of treatment fatigue could lead to alternatives to MAID, such as palliative or recovery-oriented treatments.

I respect the Senate. I value the Senate. Senators bring more than just sober second thought; they bring expertise in fields crucial to good public policy making, but senators are not elected. They are not the voice of the people. It was never the government's intention to extend MAID to those suffering from mental illness.

The government was running out of runway to meet the court-imposed deadline in the Truchon decision for amending the law to remove the requirement that death be foreseeable to qualify for MAID. It could not afford a back-and-forth game of procedural ping-pong with the Senate over its last-minute amendment to remove the mental illness exclusion from Bill C-7. It had to accept the Senate's amendment to get the bill across the finish line.

In my view, we are not ready for MD-SUMC. We cannot ascertain irremediability with any acceptable degree of certainty and objectivity. We cannot sufficiently distinguish an unfettered request for MAID on the grounds of mental illness from suicidal ideation. We are not able to separate out psychosocial factors that might drive MD-SUMC. We have not properly consulted racialized communities to take account of their views, concerns and fears, notably those of indigenous communities, and we have not built proper safeguards into the law.

We do not require the involvement of a psychiatrist in assessment nor require that a person have reasonably exhausted available treatments before making a request for MD-SUMC. The few other jurisdictions that allow MD-SUMC have this requirement.

We have not studied and understood treatment fatigue such that we can develop strategies that can possibly lead a patient to other non-lethal treatment options, and finally, we have allowed an unelected body, the Senate, to drive this agenda.

[Gord Johns, NDP, Courtenay—Alberni, BC]

Mr. Speaker, it is an honour to rise today on the unceded lands of Tseshaht and Hupacasath on Vancouver Island in Nuu-chah-nulth territory to speak to Bill C-62, which is calling for the extension of the temporary exclusion of eligibility for medical assistance in dying for persons suffering solely from a mental illness by three years, until March 17, 2027.

Clearly, without an intervention by Parliament, this expansion would come into effect on March 17, 2024, in just one month. New Democrats agree with the majority decision made by the Special Joint Committee on Medical Assistance in Dying, also known as the AMAD committee, which I will refer to it as in my speech. It reported that Canada is not adequately prepared to deliver medical assistance in dying to individuals whose sole underlying medical condition is a mental disorder.

The bill would allow more time to implement the necessary safeguards and address the capacity concerns that are expected to be the result of the expansion of medical assistance in dying for those with the sole underlying medical condition of a mental disorder. It would give medical practitioners more time to become familiar with available training and supports, while providing time for the public to become more aware of the robust safeguards and processes in place. I know this is a very sensitive and very personal matter to so many people around this country. Especially in my riding of Courtenay—Alberni, I have heard from many people about this.

We also need to ensure that we have the understanding and compassion to respect the right of an individual's choice of dignity when they have deep, prolonged and ongoing suffering. I will speak to that. Suffering from mental illness is extremely serious, and it is just as real as suffering from a physical illness. In our health care system, we clearly do not have parity when it comes to mental and physical health, and I will speak to that as well.

We must also affirm and protect the most vulnerable when we do any sort of decision-making on such a serious piece of legislation as expanding medical assistance in dying. This additional delay is necessary and needed right now to ensure that we have a health care system in place that can safely provide medical assistance in dying for those whose sole underlying medical condition is a mental disorder.

We know how we got here. The Liberal government made an ill-advised decision and did a complete 180° by accepting the Senate's amendment to Bill C-7 in the 43rd Parliament. That is what got us here. The government changed the law before any kind of comprehensive review had been conducted, and we have been trying to play catch-up ever since. I am going to speak about the important work that needs to be done, and I want us to be thoughtful in our approach to expanding medical assistance in dying.

As New Democrats, we take people's concerns and feedback very seriously. We are committed to helping find the best possible solution for Canadians in the policy of medical assistance in dying to ensure that it does what it was always intended to do. One of the biggest concerns New Democrats have with the expansion of medical assistance in dying is with the barriers that many Canadians face when they reach out for mental health treatment. Because of the Liberals, and the Conservatives before them, the chronic underfunding of our health care system has become even more apparent. It is now more than ever, as we see the disparity between mental and physical health and how people are taken care of.

We heard the Prime Minister promise to implement a new mental health transfer of $4.5 billion over five years, but he has still not done that. Even with the bilateral agreements, the Liberals are falling far short, and that would not even be enough. Everyone should be able to access mental health supports when they need it, but under the Liberal government, and that of the Conservatives before it, this has not been the reality. It is the same with all provinces and territories.

New Democrats wholeheartedly support the delay in expanding medical assistance in dying for those who have a mental disorder as the sole underlying condition, but the Liberal government needs to ensure that proper consultation happens between now and the expansion date, or it would need to be extended again. It needs to ensure that people will be protected while respecting their individual choice.

The Liberals cannot just delay the expansion either. They need to fund adequate supports and treatment options for people dealing with mental illness. Members have heard me say this repeatedly, but we need a pathway, a road map, to how we are going to achieve parity for mental and physical health and ensure people get the timely help they need when they need it.

Seven of the provinces and all three territories have said that they are not ready and have signed a joint letter to that effect, including my home province of British Columbia. That was signed by the ministers of health in those provinces and territories. They are calling for an indefinite pause on the expansion for individuals whose sole underlying medical condition is a mental disorder. That is what those ministers identified.

As New Democrats, we want to see a MAID regime where guardrails are in place to protect vulnerable populations while still allowing for personal bodily autonomy and end-of-life choices. We must make sure that people do not request medical assistance in dying because they do not have access to treatments, supports and services. This has to be absolute. The Liberals need to make sure everybody can access mental health supports. However, after nine years of carrying forward with the Conservative cuts to health care, this is where we are at right now right across the country. Help is out of reach for many people. This needs to change before medical assistance in dying can be expanded.

We know that the housing, toxic drug and mental health crises that are happening are not being addressed. I see that I do not have a lot of time left, but I want to ensure I outline that the AMAD committee heard from plenty of witnesses who cautioned the committee on expanding MAID in cases of persons suffering solely from a mental illness. I want to share what a couple of those experts had to say.

Professor Brian Mishara, who is with the Centre for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices at Université du Québec à Montréal, said, “The expert panel report on MAID and mental illness states that there are no specific criteria for knowing that a mental illness is irremediable”, and that there is absolutely no “evidence that anyone can reliably determine if an individual suffering from a mental illness will not improve.” He warned us that “any attempt at identifying who should have access to MAID will make large numbers of mistakes, and people who would have experienced improvements in their symptoms and no longer wish to die will die by [medical assistance in dying].”

We heard from many experts. The CAMH raised similar concerns.

Because I see that I only have a couple of minutes left here, I want to talk a bit about the system and the lack of access. We are talking about a crisis going on from coast to coast to coast, according to a poll done just a year ago. The Mental Health Commission of Canada and the Canadian Centre on Substance Use and Addiction released a report talking about postpandemic findings. It cited that 35% of respondents reported moderate to severe mental health concerns.

This is alarming. It should also be alarming to all parliamentarians that it found that fewer than one in three people with current mental health concerns accessed services. The report identified key barriers to accessing services as financial constraints and help not being readily available. We know that right now we are in a financial crisis, and I am sure those numbers have only gone up. It identified that one of the top stressors was between income and unemployment with mental health concerns.

We need to create a system of parity with mental and physical health. The government has not delivered when it comes to a plan, a road map, on how we achieve parity with physical and mental health. I hope in this budget, it is going to release funding on top of the bilateral agreements directly to community-based organizations as a COVID emergency recovery response because, post-COVID, we know some people are struggling financially, but the biggest concern right now and the biggest epidemic post-COVID is in mental health. I hope the government is hearing that.

I see that I have run out of time. I have a lot to say on this matter. I look forward to taking questions from my colleagues.

Government Business No. 34—Proceedings on Bill C-62

[Alistair MacGregor, NDP, Cowichan—Malahat—Langford, BC]

Madam Speaker, I would like to inform the you that I will be splitting my time.

Today, we are not debating Bill C-62; we are actually debating Motion No. 34, which is a programming motion to get the bill through the House of Commons. We are having to resort to a tactic that I do not often like to use, but time is forcing us to do this.

If the House of Commons, the Senate and Governor General do not act and we do not have this bill into royal assent by March 17, the law is going to change. Essentially, many experts have expressed an extreme amount of discomfort with that. There is a lot of professional discomfort. We have seen also from our provinces and territories that they are very uncomfortable with the pace of change that is going on.

What Bill C-62 would do is delay the implementation of MAID for persons who are suffering from a mental disorder as a sole underlying condition. The bill would further kick that can down the road until 2027. It also has a legislative requirement that the Special Joint Committee on Medical Assistance in Dying be reconvened in advance of that date. Hopefully, that committee would have the time necessary.

As parliamentarians, we have to step up to the moment. I am particularly saying this for my hon. colleagues in the House of Commons. There is plenty of blame to be assigned to the Liberals, and, trust me, I have given my fair share. We are in this situation because of an ill-advised 11th hour amendment to Bill C-7 in the previous Parliament, a bill that the government's original charter statement had presented as a reasonable argument against the expansion of MAID to people who had mental disorders. Then that bill went to the Senate and it inexplicably accepted a consequential amendment that brought us to where we are today.

Last year, we had to quickly pass Bill C-39, because, again, we were not ready for the deadline then. That kicked the can further down the road by one year. Now we find ourselves in the exact same position. I am suffering déjà vu, like a lot of my hon. colleagues are, where we now have to force this legislation to kick the can down the road another three years. I feel like I am caught between two forces right now: the ineptitude of the governing Liberals for putting us in this position and a Conservative Party that seems to just want to cause chaos in this final week.

This is a moment when the adults in the room need to step up to the plate. There is plenty of blame to be assigned, but we cannot work around the deadline and the fact that we have only two sitting weeks left to us. We are still at the second reading stage of this bill, and that is why this programming motion is necessary. That is why we need to step up to the plate and ensure that Bill C-62 is through the House of Commons by the end of this week. It still has to run the gauntlet in the Senate, and who knows what is going to happen in the red chamber. That is something for the government members to figure out.

One thing that is really good about this motion is that there is a requirement that the Standing Committee on Health be convened on Wednesday. That will allow members of that committee to question either the Minister of Health or the Minister of Justice and also have two hours to speak to witnesses. Honestly, we need to come together as a Parliament and ensure that we get this through.

It is further bolstered by the fact that seven out of 10 provinces and all three territories sent a letter to the federal government asking for an indefinite delay. These are signatures of ministers of health and ministers responsible for mental health and addiction, which are essentially the departments that are responsible for oversight of the whole medical assistance in dying regime. We have to listen to those incredibly important voices. We have to listen to their expertise. We have to honour what they are requesting in this letter.

I ask my hon. colleagues to step up to the plate and be the adults in the room. Let us get Bill C-62 passed through the House of Commons this week.

[Luc Thériault, Bloc, Montcalm, QC]

Madam Speaker, let us try to calm down a bit.

In this debate, the government is basing itself on the Special Joint Committee on Medical Assistance in Dying for its amendment to Bill C‑62.

The Bloc Québécois would have liked to lend its support. The problem is that we believe that we should not indefinitely delay the possibility of medical assistance in dying for people with an irremediable mental disorder, when no psychiatrist worth their salt has been able to treat them or relieve their suffering. After 10, 20 or 30 years of suffering, the decision whether or not to request MAID should not lie with this person, who is supposed to determine whether the patient is eligible.

We asked for an amendment to the bill. Why take three years when, last year, we were told that it would take a year to make sure that MAID for people with mental disorders could be set up in a safe and appropriate manner? The main issue we have is that, in 2015, there was an election, but there was also the Carter decision. The government and this Parliament passed terrible legislation, similar to the one Quebec adopted a year earlier.

Quebec passed a law that only covers end-of-life cases, people who are terminally ill. I want to reiterate that, in the terminal phase of life, the process of dying has begun and is irreversible. People can be well taken care of in palliative care. Good palliative care, as described by Cicely Saunders at the time, is full, comprehensive, holistic support for people as they are dying. It involves adequately managing the person's pain and suffering, both physical and emotional, and supporting their family. All of this should be done in an environment that resembles a normal environment as much as possible. However, it is possible that, all of a sudden, in the midst of this process, the patient, who is slowly dying, will request MAID because, one day, they are feeling at peace and ready to let go. That is not a failure, in my opinion. It can be seen as successful palliative care. When my colleagues are about to depart this life, I hope that they will be calm and at peace. That is what I would wish for everyone.

So Quebec had taken those steps. Then in Parliament came the Carter decision, which stated that Ms. Carter was not at the end of her life, but she was suffering a great deal. It was therefore decided that depriving her of medical assistance in dying impinged on her right to life. Why? She was being forced to end her life prematurely, when the fact is that letting her decide what happened next would empower her. It was up to her to define when her suffering became intolerable.

It was a bad law. Bill C‑7 had to be introduced. When we began studying Bill C‑7, there was another factor that had to be considered; that was in 2021.

The Carter decision states that there cannot be an absolute prohibition on MAID simply because people belong to a particular group, one that is vulnerable. It must be assessed on a case-by-case basis.

The reality is that people can and do struggle with irremediable mental disorders. Irremediability is established through a rigorous process. During that process, practitioners must be certain that the person has never refused treatment that we know would have absolutely improved their situation.

There are indeed people whose mental disorders cause intolerable suffering, and psychiatry does not help them. If anyone here wants to claim otherwise, I would say that they lack intellectual integrity. Psychiatrists cannot cure everyone; it is impossible. That said, psychiatry is rife with medical paternalism.

That being said, what we wanted was for the government, whose Bill C‑62 is based on the work of the Special Joint Committee on Medical Assistance in Dying, to plan ahead for when it might have to introduce Bill C‑62 and include another key recommendation of the special joint committee in the bill. That recommendation was presented a year ago and was the subject of a consensus. One Conservative member even joined the majority. There is a consensus in favour of advance requests.

Why was that not included in the bill? It should have been anticipated. The government knew that the date would have to be pushed back. It had a year to introduce a measure in the House that would have also covered people suffering from dementia and Alzheimer's. Why did the government not do that? We asked the government why it was not doing so when it had the chance. Quebec drafted its own legislation. It is structured, rigorous and unanimously supported in Quebec.

An Ipsos poll shows that 85% of the Canadian population supports advance requests. In British Columbia, 84% supports advance requests. In Alberta, it is 84%; in Saskatchewan and Manitoba, it is 81%; in Ontario, it is 84%, in Quebec, it is 87%; in Atlantic Canada, it is 81%. I could go on. There are other figures. They vary. The results are based on a sample of 3,500 people. That is not nothing. When will the government take action? Why has it not heard this request? Why has it not spoken with Quebec, who has worked on this issue? Why did it not hear the unanimous will of the National Assembly, just last week? Why is it afraid of its own shadow? Why do the Liberals lack courage so?

The last time they lacked courage, we ended up with Bill C‑14. What is the problem with Bill C‑14? The real problem with Bill C‑14 is not a legal problem. The problem is for a patient who is suffering, who, to satisfy the reasonably foreseeable natural death criterion, has to go on a hunger strike. We have seen that. The problem is for people who, like Ms. Gladu and Mr. Truchon, have to fight for their constitutional rights in court. When I say there is a lack of courage, that is what I mean.

My only viewpoint is the viewpoint of patients who are suffering. The only thing I am standing for here is the suffering patients' right to self-determination. Patients had to fight an uphill battle against medical paternalism when it comes to MAID.

As I mentioned last week, there was a time when the palliative care that is so dear to the heart of my Conservative friends and that I personally consider to be very important was called passive euthanasia. Doctors obstinately used aggressive life-support measures because their duty was to save their patients. As we know, every doctor thought that they could save every patient back then. It was actually doctors suffering from cancer who started to assert their right to refuse treatment. Today, cessation and refusal of treatment are part of what are considered to be good medical practices.

Why are we not studying the bill today? The government is imposing a gag order. We will not be overly critical of this decision. I understand that this has to be done before March 17. We are not getting too worked up about this, but still, we have not consented and will not consent to this. Why not? It is because we wanted a bill that was based on the recommendations from the Special Joint Committee on Medical Assistance in Dying. I want answers from the government in that regard.

Why the delay in expanding medical assistance in dying to people with mental health issues? We did what the committee asked. Bill C‑62 even provides for the Special Joint Committee on Medical Assistance in Dying to reconvene in order to determine whether the groundwork has been laid. That is what we are doing. We basically took the recommendation and inserted it into the bill. Then, there is the issue of advance requests. There is a consensus on that across the country, but the government lacks the courage of its convictions.

The Liberals are afraid of demagoguery because there has been a lot of it on this issue. They are lumping everything together. However, at some point, they need to be consistent in their approach. The Liberals are well aware that the state's role is not to decide for the patient what is best for them when it comes to a decision as personal as one's own death. The state or the patient's neighbour is not the one who is going to die. The state's role is to determine the proper conditions and ensure that they are put in place so that patients can make a free and informed choice. If people are worried about abuse or the slippery slope when it comes to advance requests, then they should look at Quebec's law, which is a model to follow.

The government could have easily inserted elements of the Quebec law into its regulations. It is all well and good to say that the law is a little vague, but the amendment we are making to the medical assistance in dying legislation, expanding section 241 of the Criminal Code, is followed by a procedure, regulations on enforcing regulations. That is where the various safeguards are put in place.

There are standards of practice when it comes to mental disorders. A year ago, a committee began looking at standards of practice, and they will be sent to the regulatory bodies in each province, namely the colleges of physicians. Once we have clear guidelines and standards of practice and the criteria I was talking about earlier are met, someone in a suicidal crisis will not have access to medical assistance in dying.

It bears repeating, because I am hearing a lot of confusion over this. A suicidal person is not eligible for medical assistance in dying, even if they suffer from a mental disorder and are in suicidal crisis, and even if they have recently been admitted to care and diagnosed. I have often asked psychiatrists if they thought that giving access to medical assistance in dying to people with mental disorders could also provide an opportunity for prevention. Some people commit suicide and no one sees it coming. No one knows those individuals today, no physician took them on.

For example, knowing that MAID is an option, a person might come forward because they are suffering and want to exercise that option. Well, that person would not qualify. However, they would then be taken care of and get the treatment they need, since suicidal ideation is reversible. There is no question about that. However, it is not about those patients. When we asked the chair of the expert panel, psychiatrist Mona Gupta, how many patients in her practice would have been eligible, she told us of two or three patients over her entire practice. Still, these are people who are suffering.

When people talk about the fact that the resources are not there—the resources in terms of someone to assess capacity, for an independent psychiatrist to look at a case—I would point out that right now, the decision-making capacity of a person struggling with a mental disorder, but who has cancer, for example, is verified. Psychiatrists are currently assessing the decision-making capacity of people with a mental disorder and a comorbidity. Depending on their condition, practitioners are able to determine the decision-making capacity of these people who have a mental disorder.

The Supreme Court was clear: Not allowing these people to access MAID creates stigma. Not only does it stigmatize them, it discriminates against them. Why infantilize and weaponize people who have a mental disorder and who, in their entire existence, have not found treatment that can alleviate their suffering?

I rather like having discussions and debating with my Conservative colleagues. They have a sense of conviction, but there are some Conservatives who use scare tactics and conflate everything. It is not enough to repeat some 20 times that someone came to say that irremediability is hard to address. Everyone agrees. Even the expert panel starts with that. They did not hide that fact. In fact, they say that because irremediability is hard to establish there must be safeguards and precautionary principles put in place.

I therefore move the following amendment:

That the motion be amended in subparagraph (b)(ii):

(a) by adding after the words “be deemed referred to a committee of the whole,” the words “that an instruction be deemed to have been given to the committee granting it the power to expand the scope of the bill so as to take into account provincial medical assistance in dying frameworks for advance requests from persons who have an illness that could deprive them of the capacity to consent to care,”;

(b) by replacing the words “deemed reported without amendment” with the following: “deemed reported with the following amendments:

That the bill be amended by adding the following new section 241.21 to the Criminal Code:

New section 241.21

Medical assistance in dying eligibility criteria for advance requests

“241.21 The government of a province may establish a medical assistance in dying framework for advance requests from persons who have an illness that could deprive them of the capacity to consent to care, in accordance with the laws of that province.””; and

(c) by replacing the words “deemed concurred in at report stage” with the following: “deemed concurred in at report stage, as amended”.